Psychiatry in other medical settings (including eating disorders)

Question 1

What is the psychopathology in anorexia nervosa (AN) and bulimia nervosa (BN)?

Answer 1

An overvalued idea

Question 2

What are the two measures used to diagnose anorexia nervosa (AN)?

Answer 2

1) Body weight maintained at least 15% below normal
OR
2) A BMI below 17.5kg/m2

Question 3

What endocrine disturbances can occur in AN?

Answer 3

1) Amenorrhoea in post-menarchal women
2) Loss of sexual interest
3) Raised GH
4) Raised cortisol
5) Reduced T3.
6) Pubertal events delayed or arrested in certain age groups.

Question 4

What body weight change is there in BN?

Answer 4

Pts usually have a normal weight

Question 5

How do BN pts purge?

Answer 5

Vomiting, laxatives and diuretic use.

Question 6

What is Russell’s sign?

Answer 6

Calluses on the back of hands when the hand has been used to induce vomiting.

Question 7

What is the ICD-10 criteria for AN?

Answer 7

All of the below:

1) Low body weight (BMI)
2) Self-induced weight loss
3) Overvalued idea
4) Endocrine disturbances (failure to make expected development if prepubertal)

Question 8

What is the ICD-10 criteria for BN?

Answer 8

All of the below:

1) Binge eating
2) Methods to counteract weight gain
3) Overvalued idea

Question 9

What is an important s/e of BN?

Answer 9

Hypokalaemia with repeated vomiting which can be life threatening. This should be treated gradually and the patient should be encouraged to eat potassium rich foods i.e. bananas.

Question 10

What is the F:M ratio for BN and AN?

Answer 10

They are both 10:1 F:M

Question 11

What is the prevelance of AN and BN?

Answer 11

AN = 1%
BN = 4%

Question 12

What are the ages of onset of AN and BN?

Answer 12

AN –> mid to late adolescence

BN –>late adolescence to early adulthood

Question 13

Which social classes are more at risk of BN and AN?

Answer 13

Social economic class is no longer thought to play a large role.

Question 14

Which neurotransmitter is thought to play a part in AN and BN?

Answer 14

High serotonin (thought to reduce appetite)

Question 15

Is AN and BN thought to have genetic causes?

Answer 15

Yes (shown by monozygotic twin studies)

Question 16

What family traits are thought to be linked to AN and BN?

Answer 16

1) overprotective
2) over involved
3) avoid conflict
4) resistant to change

Question 17

What is the first line treatment in AN?

Answer 17

Psychoeducation about diet and nutrition.

Question 18

What is the best outpatient treatment for AN?

Answer 18

Brief outpatient psychotherapy with the encouragement of family involvement which involves:
1) CBT
2) IPT
and others

Question 19

What the reasons for hospitalisation for AN?

Answer 19

1) BMI

Question 20

What medication is used in AN?

Answer 20

The use of medication is limited and special care should be taken in patients with a very low weight. Fluoxetine may be helpful in maintaining weight gain and preventing relaps

Question 21

What treatments are the used in BN?

Answer 21

1) Psychotherapy

2) TCAs and SSRIs

Question 22

What % of AN pts return to normal?

Answer 22

50%

Question 23

What fraction of pts fail to recover from anorexia?

Answer 23

1/3

Question 24

What is the psychiatric disorder with the highest mortality? (what is the mortality %?)

Answer 24

AN with >10% mortality

Question 25

What % of AN pts go on to develop healthy weight BN?

Answer 25

25%

Question 26

What % of BN pts make a full recovery within 5 years?

Answer 26

60%

Question 27

What are dissociation disorders?

Answer 27

Disorders that describe a disruption in the integration between

consciousness, memory, identity, perception and movement

and is where a person’s behaviour and personality become separated.

Question 28

Give 4 examples of dissociation disorder.

Answer 28

1) Dissociative amnesia (memory loss of recent events)
2) Dissociative fugue – purposeful sudden travel beyond a person’s normal range where self care and normal social interactions are maintained
3) Dissociative stupor – psychomotor retardation, unresponsiveness, mutism, lack of movement
4) Dissociative convulsions – pseudo seizures i.e. not real seizures

Question 29

What types of psychotherapy are used in BN?

Answer 29

Psychoeducation,

CBT,

etc

Question 30

What are the drug therapies used in BN and what symptoms do they reduce?

Answer 30

TCAs and

SSRIs (fluoxetine 60mg)

have been shown to reduce bingeing and purging behaviours

Question 31

Describe dissociative amnesia?

Answer 31

memory loss of recent events

ranging from hours to years

Question 32

Describe dissociative fugue?

Answer 32

purposeful sudden travel

beyond a person’s normal range

where self care

and normal social interactions are maintained

Some degree of amnesia with

no understanding or knowledge of the reason for the flight

Question 33

Describe dissociative stupor?

Answer 33

psychomotor retardation,

unresponsiveness,

mutism,

lack of movement

Question 34

Describe dissociative convulsions?

Answer 34

pseudo seizures i.e. not real seizures

Question 35

What does ICD-10 require there to be evidence of in dissociation disorders?

Answer 35

ICD-10 requires there to be some evidence of psychological causation

in association with the

onset of dissociative symptoms.